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CHANGE EXISTING PROVIDER ENROLLMENT INFORMATION

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Report Changes to your Enrollment Records

You must report changes of information in your Medicare enrollment records within 30 days for:

  • Change(s) in bank account information
  • Change(s) in ownership, including change in an authorized or delegated official 
  • Change(s) in practice location
  • Final adverse legal action(s)
  • Independent diagnostic testing facility (IDTF) supplier change(s) in general supervision
  • Medicare diabetes prevention program (MDPP) supplier change(s) in coach roster
  • Opioid treatment program (OTP) supplier change(s) in Program Sponsor/Medical Director

All other changes to your existing Medicare enrollment records must be reported within 90 days.

The request may be submitted no more than 60 days prior to the effective date of the change reported on the application.

Reminder: Terminate reassignments and employment arrangements timely.

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